Working as a nurse / professional elder care giver in Germany
Author: Robert Mittelstädt (Justiziar), bpa – Bundesverband privater Anbieter sozialer Dienste e.V.
Disclaimer: “This information is not meant as legal advice and is supplied without liability”.
(Posted with permission from the author.)
Because of its aging population and increasing demand for nursing and elder care, Germany has a big shortage of licensed nurses and professional elder care givers. That is why many nursing homes, day care facilities and home care services for senior citizens are hiring health care personnel from outside of Germany and especially the Philippines. Nurses from the Philippines have a long tradition in Germany, even going back to the 1960s.
What exactly does the work as an elder care nurse look like in Germany?
Professional elder care in Germany is carried out in 3 different sectors: Stationary long term care in elder care homes, ambulatory home care services and day care centers for senior citizens. For a good impression of the work you can watch this video by bpa e.V. (Germany’s biggest association of private care homes and home care providers with more than 10.000 providers with more than 300.000 employees): https://youtu.be/l11kx-VpAzI
In the German professional elder care sector registered nurses are very common and widely considered and accepted as skilled professionals (“Fachkräfte”). Nurses in Germany undergo 3 years of training and school apprenticeship (“Ausbildung”) with a total of 4.600 hours in which they already do practical nursing work with real patients under supervision of a professional trainer. Registered nurses in hospitals and in the elder care sector perform the treatment which is ordered by a licensed physician / doctor. I addition to the treatment, the nurses /elder care givers also provide the basic care such as washing the patients or helping with basic needs, getting un/dressed, going to the bathroom as well as social and mental care needs. Especially for the professional elder care sector in Germany there is also the professional elder care giver (“Altenpfleger/in”) which basically is a specialized nurse for elders. They are also graduates with a 3-year apprenticeship. In the future, the German government plans to have only one education for all nurses, pediatric nurse and elder care givers in Germany – like it is in most countries, although this step is highly controversial in Germany.
If you are a nurse who would like to work in the professional elder care sector in Germany you should ask yourself whether or not elder care is a field in which you would like to work. It is different from hospital work. There are no surgeries and intensive care units (sometimes respiratory care), but there are a lot of patients with illnesses related to their old age, for example Alzheimer (or other form of dementia), incontinency and skin wounds (bedsore). Most patients have a need for many different daily medications, blood pressure measurement, diabetes care etc. The care relationship with patients is not for days but for months or even years. This is often considered as a big advantage by professionals in the elder care sector. But it can sometimes be stressful and professional nurses and care givers need a caring and loving attitude towards elderly people.
How are the career perspectives and salaries in the German elder care sector?
The career perspectives are really good! You can work as a professional nurse and undergo further special geriatric trainings, become a team- or group-leader or even chief nurse.
Your salary will depend greatly on your professional experience and your performance. Also, in some regions of Germany the pay is better than in other regions. Graduate nurses in a full time position (40 hours per week) can expect to start out with monthly 2.200 – 2.800 Euros (before taxes). Senior experienced nurses in leading positions can make up to 3.000 – 4.000 Euros per month (before taxes). For nurses who do not yet have full professional recognition in Germany, salaries are usually lower and range from 1.700 – 2.200 Euros per month (on a full time basis) as they can only be considered as nurses assistants or elder care giver assistants. All bpa member employers pledged to give equal treatment and pay to foreign employees as to German employees.
What requirements are there before a Filipino nurse can start working in Germany?
Before a Filipino nurse can start working in Germany there are three basic requirements that need to be fulfilled.
Here, you will read more about these 3 basic requirements:
1. Successful completion of the level B2-exam in German language proficiency
For most nurses the first step is the B2-German language proficiency as it is a key requirement for the nursing license in Germany and the work visa/permit.
The B2-level is an advanced intermediate level of German language proficiency according to the Common European Framework of Reference for Languages. There are 6 levels, starting with A1, A2, going up B1, B2, finally C1 and C2. With intensive German classes and home study it will take from 500 – 800 lesson units (each 45 min.) to reach B2 which translates into 6-18 months of German study, depending on the intensity. Because of the common roots of the German and English language, German for Filipinos is easier to learn than for other Asian nationalities.
At the moment the German embassy in Manila only accepts language certificates by Goethe (TestDaF), Telc and ÖSD. In the Philippines there are many German language schools, but only few with official authority to hold acknowledged B2-exams:
a) Goethe-Institute in Manila: www.goethe.de/ins/ph/de/
b) ÖSD examination centers in Manila and Cebu-City: http://www.osd.at/default.aspx?SIid=64&LAid=1
c) Language schools with regular access to official Telc-examinations in Manila
or the Telc examination centers in Cebu City and Iloilo City: https://www.telc.net/en/candidates/find-examination-centre.html?tx_telcexamcentres_map[filter][country]=Philippines
If you are already located in Germany, there are many language schools and they are usually accepted by the recognition authorities, such as:
a) Public institutes of higher learning (“Volkshochschulen”): www.volkshochschule.de
b) Private language schools („Sprachschulen“): just google „Sprachschule deutsch B2“ and you will find many results with language schools offering B2-courses near you in Germany.
2. Recognition of your nursing degree in Germany
For the recognition process it is best if you already have established contact to your future employer as he can help you with this process and can negotiate with the German authorities for you. Alternatively, the German-Filipino placement agency can handle this issue together with you.
On the information website of the German Government www.anerkennung-in-deutschland.de there is an “ANERKENNUNGS-FINDER” (German for “recognition-finder”) where you can type in “Krankenpfleger” (which means “nurse” in German). Then you type in which city or community you plan to work in Germany. Then the “ANERENNUNGS-FINDER” gives you the exact contact information of the responsible local authority for the formal recognition process. In most cases the local authority belongs to a regional government agency or state health ministry which is responsible for accreditation and recognition of foreign health care professionals.
In order to have your documents officially recognized in many cases it is necessary to present or send in the original or authenticated copy of your diploma and additional documents such as your college curriculum, letter of good standing, proof of professional experience as a nurse, a recent health certificate, etc. But for your own safety, you should not send in original versions of your documents as they may get lost. Usually the German authorities have a list with all the required documents and usually they also accept e-mail attachments of your documents for a preliminary assessment. Legally, all the documents also have to be translated into German by a licensed translator in Germany. Nevertheless, many authorities will also accept documents in English.
The recognition process can be lengthy due to slow working authorities in Germany. By law, they have 4 months’ time for their decision. Therefore, it is important to file your documents as early as possible, as the deadline only starts once you turned in all required documents.
The health authority will then send you a decision about a full or partial recognition of your professional qualification as a nurse. In many cases – if you do not have proven at least 2-3 years of professional experience as a nurse – you will receive only partial recognition and for a full recognition the German authority will offer you a) either to enroll in an adaption course (“Anpassungskurs” in German) for the missing contents of your nursing education or b) to take the knowledge exam for foreign nurses (“Kenntnisprüfung”) in Germany. If you are still in the Philippines and received only partly recognition, then for a work visa you will be required to show proof that you registered for one of the following:
a) Adaption course / “Anpassungskurs”
If you choose to enroll in an adaption course you can ask the German authority for a list of courses near your projected place of work. In addition the public German “Netzwerk-IQ” (www.netzwerk-iq.de) can provide you with a list of adaption courses which in many cases even are funded by the Government or European Union. The “Netzwerk IQ” has offices in all German regions and offers free of charge consultations to migrants. In many cases the adaption course will take 9-18 months and is carried out by an accredited nursing school or higher learning institute. The costs vary between 1.500 and 4.000 Euros. Public funding or public loans or financial aid by the employer in many cases are available. The adaptions courses are especially designed for foreign nurses who still have bigger difficulties with the German language and include German medical language training.
b) Knowledge exam / “Kenntnisprüfung”
A faster but sometimes more strenuous way to obtain your full recognition of your professional nursing qualification in Germany is the knowledge exam, which basically is a single day state nursing licensure exam in German language. A foreign nurse can decide to take the exam to prove that she/he has equal professional skills as German nurses. The exam must be offered by the authorities at least once every 6 months. It is highly recommended that foreign nurses enroll in a preparation course for the exam. In this preparation course you will learn the necessary medical terms in German language and about the possible content of the exam. Preparations courses sometimes can be hard to find but you can also look for it at www.netzwerk-iq.de. In the capital region of Berlin/Brandenburg the “Akadamie für Gesundheit” (www.gesundheit-akademie.de) offers regular preparation courses of 2-3 months. You can also ask your German employer about it. There are even online-courses as from www.apm-nrw.de (the actual exam can only be taken in Germany). The costs of the exam vary and can be between 150-500 Euros. The preparation course can cost between 1.000 up to 3.000 Euros, depending on the duration.
Once you have passed the adaption course or the recognition exam you can file for the full nursing license in Germany, together with your proof of German proficiency and certificate of good standing as well as health certificate.
3. Work visa from the German embassy in Manila and departure permit by the POEA or work permit from the local German authority for foreigners
Before you can come to Germany or – if you are already located in Germany – before you can start to work there, you will have to apply for a work visa at the German embassy in Manila or at a local authority for foreigners in Germany. If you have been recruited by a recruitment/placement agency they will often handle this part for you or at least help. Please look there for visa appointments, which sometimes are difficult to obtain.
There is a strict visa appointment system in place and the visa procedure and forms should be carefully obeyed. You can either file for a work employment visa according to § 18 of the Residency Act, if you already have full recognition or for a recognition visa according to § 17a of the Residency Act, if you have only partial recognition and need to enroll in an adaption course or a preparation course for the knowledge exam. You should have all the necessary documents ready for the application, including B2-language certificate, employment contract, proof of full professional recognition in Germany or – in case of partial recognition - proof of registration in an adaption course or knowledge exam in Germany, pre-approval by the German employment agency (“Bundesagentur für Arbeit” / ZAV) . The full list of requirements can be downloaded from the embassy’s website: http://www.manila.diplo.de/contentblob/4758944/Daten/7815212/MB_Nurses.pdf
The embassy also hosts a special information website for Filipino health care professionals: http://www.manila.diplo.de/Vertretung/manila/en/06/Career_20Nurse_20in_20Germany.html
Filipino workers who want to leave the Philippines for overseas employment must hold a permit issued by the Philippine Overseas Employment Administration (POEA). A so called OEC-Sticker (Overseas Employment Certificate) will be visibly placed in your passport. In many cases the recruitment/placement agency will help you with this. But you should start the process in good time before leaving the Philippines: www.bmonline.ph/
Once you obtain your work (employment) visa from the German embassy and your departure permit from the POEA you are allowed to fly to Germany and work there.
If you are already located in Germany you will also have to apply for a work permit (“Arbeitserlaubnis”) at your local authority for foreigners (“Ausländerbehörde”). With your professional recognition you can apply for an “Aufenthaltstitel zur Beschäftigung” (work permit) according to § 18 of the Residency Act (“Aufenthaltsgesetz”). In case of partial recognition and further adaption or preparation courses for the knowledge exam you can apply for a residency and work permit according to § 17a of the Residency Act. Once you obtain your work permit, you are allowed to work in the region or city which is outlined on the work permit card. If a specific employer is outlined on the work permit you can only work for this employer. If you want to change you’re your place of employment or employer, the work permit has to be altered by the authorities first.
How can I apply for a job in the elder care sector in Germany?
If you are interested in a job in the elder care sector in Germany you can either go to the internet website of bpa e.V.:
There you can find a lot of job offers at bpa member facilities where you can directly apply. If you do not find a suitable position near your desired location in Germany you can also e-mail your application to email@example.com and bpa will look for an employer for you.
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